Barriers to Care & Treatment Practices in HIV+ Latinos in US-Mexico Border Region

护理障碍

• 批准号: 7426983
• 负责人: Maria Luisa Zuniga de Nuncio
• 金额: $ 19.09万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-26 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7426983
• 关键词: AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Administrator; Alternative Medicine; Behavior; Behavioral; Behavioral Model; Budgets; California; Caring; Characteristics; Code; Communities; Community Developments; Complementary and alternative medicine; Condition; Consensus; County; Data Collection; Depth; Development; Disease; Face; Folk Medicine; Geographic state; Goals; HIV; HIV Seropositivity; Health Care Seeking Behavior; Health Services; Herb; Herbal Medicine; Hispanics; Interview; Interviewer; Latino; Lead; Life; Logistic Regressions; Measures; Medicine; Methodology; Methods; Mexico; Minority Groups; Numbers; Participant; Patients; Persons; Plant Roots; Plants; Provider; Public Health; Qualitative Methods; Qualitative Research; Recruitment Activity; Regression Analysis; Religion and Spirituality; Reporting; Research; Research Methodology; Research Personnel; Sampling; Services; Side; Societal Factors; Solutions; Spirituality; Staging; Stigmata; Surveys; System; Testing; United States; Vitamins; base; care delivery; care seeking; community based participatory research; design; experience; health care delivery; health care service utilization; health disparity; improved; optimism; research study; social stigma; theories

DESCRIPTION (provided by applicant): The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. California ranks among the top five states with highest numbers of Latino AIDS cases and Latinos comprise 66% of reported HIV cases in San Diego County's southern region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). We will assess barriers to HIV care and care practices among Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors. We propose a community-based binational collaborative study that builds on existing academic-community partnerships and employs quantitative and qualitative methods to address aims. Aim 1: To assess binational health care seeking behavior and HIV treatment utilization, including access to ARVs and use of CAM (e.g. folk medicine, herbal medicine) among HIV-positive Latinos who currently reside in Tijuana, Baja California, Mexico or San Diego, CA. Aim 2: To determine specific barriers to HIV care, including manifestations of HIV-related stigma, mobility and spirituality/religiosity among HIV-positive Latinos who reside in Tijuana and San Diego. Aim 3: To explore provider and system-level barriers to continuity of HIV care and receipt of ARVs in HIV-positive Latinos within the health care delivery context of both sides of the US- Mexico border. To address Aims 1 and 2 we will conduct a quantitative study, based on interviewer- administered surveys with 200 HIV-positive persons (100 participants recruited from both sides of border). We will use descriptive and multivariate logistic regression statistical analyses to test specific hypotheses. To meet Aim 3, we will purposively sample 20 providers/administrators, conducting in-depth interviews on experiences with patient barriers to HIV care. Following Grounded Theory methods, data collection and analysis will include development and revision of interview guides using constant comparison method. The investigator team will independently code and reach consensus on interview coding to reflect themes/issues, accounts of behaviors, and opinions on organizational/system characteristics that influence health services. This study will decrease health disparities in HIV-positive Latinos through improved understanding of HIV care-seeking behavior; HIV care practices}including CAM use; development of community-based and culturally-relevant research methods and measures; and advancing efforts to positively impact care delivery in Latinos living in the US- Mexico border region and in other US Latino populations living with HIV/AIDS. PUBLIC HEALTH RELEVANCE The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). The proposed study will assess barriers to HIV care and care practices among HIV-positive Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors.

描述（由申请人提供）：我们以社区为基础的参与性研究的目标是确定美国艾滋病毒阳性拉丁美洲人中艾滋病毒护理的障碍。墨西哥边境地区。加州是拉丁裔艾滋病病例最多的五个州之一，拉丁裔占圣地亚哥县南部地区报告的艾滋病病例的66%。拉丁美洲人在艾滋病毒护理和进入艾滋病毒疾病晚期护理方面面临巨大障碍，但对此原因知之甚少，可能涉及与耻辱，艾滋病毒治疗乐观主义和使用传统，补充和/或替代药物（CAM）有关的问题。我们将评估在美国的拉丁美洲人中艾滋病毒护理和护理实践的障碍。墨西哥边境地区应用Andersen & Aday的卫生服务使用行为模型作为我们的概念框架，研究环境，结构，行为和社会因素。我们提出了一个以社区为基础的两国合作研究，建立在现有的学术社区的伙伴关系，并采用定量和定性的方法来解决目标。目标1：评估目前居住在蒂华纳、下加利福尼亚、墨西哥或加利福尼亚州圣地亚哥的艾滋病毒阳性拉丁美洲人的两国就医行为和艾滋病毒治疗利用情况，包括获得抗逆转录病毒药物和使用CAM（如民间医学、草药）。目标二：确定艾滋病毒护理的具体障碍，包括居住在蒂华纳和圣地亚哥的艾滋病毒阳性拉丁美洲人中与艾滋病毒有关的耻辱，流动性和精神/宗教信仰的表现。目标三：探讨在美国-墨西哥边境两侧的卫生保健提供背景下，艾滋病毒阳性拉丁美洲人继续接受艾滋病毒护理和接受抗逆转录病毒药物的提供者和系统层面的障碍。为了实现目标1和2，我们将根据对200名艾滋病毒阳性者（从边界两侧招募100名参与者）进行的访谈调查进行定量研究。我们将使用描述性和多元逻辑回归统计分析来检验特定的假设。为了达到目标3，我们将有目的地抽样20个供应商/管理人员，进行深入的采访，对患者的艾滋病毒护理障碍的经验。根据扎根理论方法，数据收集和分析将包括使用持续比较方法制定和修订访谈指南。研究者团队将独立编码并就访谈编码达成共识，以反映主题/问题、行为描述以及对影响卫生服务的组织/系统特征的意见。本研究将通过以下方式减少艾滋病毒阳性拉丁美洲人的健康差异：提高对艾滋病毒求医行为的理解;艾滋病毒护理实践，包括CAM的使用;开发基于社区和文化相关的研究方法和措施;以及推进对生活在美国-墨西哥边境地区的拉丁美洲人和其他美国艾滋病毒/艾滋病感染者的护理提供产生积极影响的努力。公共卫生相关性我们以社区为基础的参与性研究的目标是确定在美国艾滋病毒阳性的拉丁美洲人中艾滋病毒护理的障碍。墨西哥边境地区。拉丁美洲人在艾滋病毒护理和进入艾滋病毒疾病晚期护理方面面临巨大障碍，但对此原因知之甚少，可能涉及与耻辱，艾滋病毒治疗乐观主义和使用传统，补充和/或替代药物（CAM）有关的问题。这项拟议中的研究将评估美国艾滋病毒阳性拉丁美洲人在艾滋病毒护理和护理实践方面的障碍。墨西哥边境地区应用Andersen & Aday的卫生服务使用行为模型作为我们的概念框架，研究环境，结构，行为和社会因素。